Guest, stay home, stay safe, save the NHS. Stay up to date with information about keeping yourself and people around you safe here and GOV.UK: Coronavirus (COVID-19). Think you have symptoms? NHS 111 service is available here.

Doctor said my Hba1c is too low!!!

Over three years I have managed to reduce my Hba1c from 88 to 34. After my last visit to the doctor I was told that my Metformin dose was being reduced from 2 x 500mg a day to just one. The reason given and I quote "We don't like people with type 2 diabetes going to low with their Hba1c" is this really true? And why??

Congratulations of your great progress. Only one metformin a day will reduce the work your kidneys need to do to excrete any surplus drug. The comment your doctor made shows that s/he has low expectations of most Type 2 diabetics. These will, of course, be fulfilled by patients who stick to the standard NHS dietary advice!

On this trial, they put people with diabetes on intensive treatment attempting very tight blood sugar control by upping medication (more insulin, more sulfonylureas -- probably leading to more swings and more hypos). The outcome was that people did worse on intensive treatment.

Consequently, this was interpreted as diabetics doing worse on tight blood sugar control and communicated to HCPs.

However, I believe normal blood sugars achieved on lchf/keto are very different from those achieved by intensifying medication. So, in my mind nothing to worry about.

On this trial, they put people with diabetes on intensive treatment attempting very tight blood sugar control by upping medication (more insulin, more sulfonylureas -- probably leading to more swings and more hypos). The outcome was that people did worse on intensive treatment.

Consequently, this was interpreted as diabetics doing worse on tight blood sugar control and communicated to HCPs.

However, I believe normal blood sugars achieved on lchf/keto are very different from those achieved by intensifying medication. So, in my mind nothing to worry about.

By the way, congrats on your HbA1c -- great result and well done.

Click to expand...

Indeed, although proponents of the overflow hypothesis posit that this is because heavy duty hypoglycaemics forcibly push glucose from the blood into the tissues where it does most of its damage. Not a factor with Metformin of course. But yes you’re right, this probably explains where the misplaced concern comes from.

Staff Member

Well done on your number of 34!
I have maintained my HbA1c mid 30s for the last two years whilst continuing on Metformin x 3 per day along with a low carb diet!
My GP is happy for me to continue on it as am I. Have you considered that Metformin has other benefits, so you might like to reconsider once you are aware of them. Here’s an article about it:https://www.lifeextension.com/magazine/2001/9/report_metformin/Page-01

Indeed, although proponents of the overflow hypothesis posit that this is because heavy duty hypoglycaemics forcibly push glucose from the blood into the tissues where it does most of its damage. Not a factor with Metformin of course. But yes you’re right, this probably explains where the misplaced concern comes from.

Click to expand...

As I understand it taking hypoglacemic agents such as insulin or sulphonureas is taking the glucose out of the blood and into the micro and macro vessels whereas low blood glucose achieved through diet and lifestyle means you have turned off the overflow tap of glucose and not merely widened the drain.
It is possible that the OPs GP is thinking of type 1 diabetics where such a low HBA1c would indicate periods of hypos with those attendant dangers...I can't think of any other reason for it to be a problem when just taking metformin.

Thanks for all your replies, a lot to ponder on. I need to ask her (the doctor) for an explanation. A factor that might be relevant is that she changed my blood pressure pills from Ramipril to Losartan, perhaps they are more expensive? And the practice is going over budget?

No, she seemed shocked at the 34 to the point that it seemed she was annoyed!

Click to expand...

Have you had your blood pressure checked with a 24 hour monitor rather than just at the surgery?
You may be able to come off those meds too... my hypertension normalised after a few months of keto and fasting.

Have you had your blood pressure checked with a 24 hour monitor rather than just at the surgery?

Click to expand...

This times a hundred. My doctor tried her best to diagnose me with hypertension three years ago, but the 24h monitor revealed completely normal blood pressure. The funny thing is that to this day, the DN takes my blood pressure in the surgery and records high results on the system, despite acknowledging the existence of white coat syndrome, despite knowing that I exhibit it, and despite seeing the data from my own machine taken once per week every week.

My annual reviews are like paint-by-numbers. Godda tick those boxes! The only blood tests I'm interested in, they don't even do (and don't understand). It all just feels like a potential sales opportunity for pharmaceuticals and an excuse for getting a ticking-off because "...you know you can eat SOME sugar!!"

Honestly it's getting increasingly pointless going. I may decline next year. Sorry for going off on a tangent, but amateur HCPs really wind me up.